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Peter Hotez, M.D, Ph.D. Headshot

The New HHS Secretary and America's Neglected Infections of Poverty

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SYLVIA MATHEWS BURWELL
ASSOCIATED PRESS

In her decade-long tenure at the Gates Foundation, Sylvia Mathews Burwell learned a lot about the close links between disease, poverty, and development. To be sure, the new Health and Human Services Secretary will be inundated with tough and pressing issues such as the Affordable Care Act and the start of a second decade of flat funding for the NIH, among others. But Ms. Burwell's deep knowledge of global development will also position her to tackle a unique but mostly hidden problem among the poorest Americans.

More than five years ago, new information came to light about a group of chronic and debilitating neglected infections that mostly occur among the 20 million Americans living in extreme poverty. These neglected infections closely resemble the neglected tropical diseases -- parasitic diseases and related infections -- that plague the billion people living below the World Bank poverty line. In some cases, the diseases are the same.

America's neglected infections of poverty affect the extreme poor living in the southern United States, especially Texas and the Gulf Coast. They are not rare diseases. Today, hundreds of thousands of Americans live with Chagas disease, a debilitating heart condition. A new economic analysis attributes $864 million in economic losses in the U.S. to Chagas disease. At least two parasitic worm infections that cause neurologic deficits are common among the poor and disproportionately strike people of color.

Dengue fever is a mosquito-transmitted viral infection that today is decimating parts of Brazil, India, and Indonesia. Over the last decade dengue has emerged in Texas and Florida where it could become a leading health disparity among impoverished families exposed to mosquito bites because they live in squalor and degraded housing and environmental conditions. Other insect transmitted viral and bacterial infections include West Nile virus infection and murine typhus. In all, at least 10 major neglected infections of poverty have been identified, which together affect millions of impoverished Americans.

Neglected diseases affect not only health but also a person's or family's economic potential through adverse effects on worker productivity, child development, and pregnancy.

It would therefore be exciting to see the new HHS Secretary call for a comprehensive program to address America's neglected infections. The needs are pervasive, but priorities include initiating programs of active surveillance to actually assess the full extent of these diseases in poor communities, and to determine how they are transmitted. It is erroneously assumed that most of these neglected infections are imported through immigration, whereas our National School of Tropical Medicine of Baylor College of Medicine together with the Harris Health System is diagnosing and treating individuals who have never left Texas or even Houston. Sadly, most physicians and health care professionals are not trained in how to recognize, manage, or treat neglected infections, so that educational outreach and efforts to make health care professionals aware of these diseases are needed. Finally, we need new and improved diagnostics, and new interventions such as drugs and vaccines. Thus focused research and development initiatives will need to be introduced.

The new HHS Secretary will have a lot on her plate in 2014. It is my hope that with her unique skill set, Ms. Burwell will address this vital and most glaring health disparity among the poorest of the poor in the southern United States.

Peter Hotez is president of the Sabin Vaccine Institute, Texas Children's Hospital Endowed Chair in Tropical Pediatrics, and dean of the National School of Tropical Medicine at Baylor College of Medicine. He is also Baker Fellow in Disease and Poverty at Rice University.

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